Monthly Archives: April 2016

Imagine that?….It doesn’t work and costs more…..More Bad News for Obamacare

Recently the Blue Cross Blue Shield Association published a report detailing the effects of the Affordable Care Act legislation on consumers and insurance companies. Now granted, the BCBSA is a conglomeration of independent BCBS insurers so we must read the document with a pinch of skepticism. In the analysis, the BCBSA collected data of every individual market health insurance carrier and product sold in the US.

Major Points to consider from the report:

Choice of carriers declined in all markets

United Healthcare (UHC) has confirmed that it will be dropping out of a majority of ACA exchanges in 2017. While posting a predicted loss of $650 million dollars in 2016 (after a loss of $475 million in 2015), United executives are concerned that more losses are on the way if they continue to insure the Obamacare pool of patients. With the departure of UHC, many worry that choice will decline even further—some areas may only have as few as two choices. Ultimately, this move will drive prices even higher for exchange participants. Fewer choices almost always result in less competition –less competition can lead to lower quality products and care. According to a study conducted by Kaiser, the impact of shrinking choices in the marketplaces can be very significant—particularly in southern states and rural areas. United accounts for nearly 71% of all enrollees currently and 29% of counties that are currently served by Untied would only have ONE choice of carrier if UHC pulls out. Overall, 1.8 million enrollees will be left with 2 choices of carrier and 1.2 million will have only ONE choice.

-New enrollees received significantly more care and those insured by the exchanges had costs nearly 25% higher as opposed to those insured via employers

Not surprisingly, those enrolled in the exchanges accounted for more emergency room visits, more inpatient admissions, more prescription drug costs and inpatient admissions than those that were insured in traditional employer based systems. Many Obamacare enrollees have waited until a major illness occurs before signing up and gaining access to care. Once treatments are completed, many of these same patients simply drop out—thus skewing the insured pool to those with higher costs–with fewer “young and healthy” patients on board to help fund the more expensive treatments required by many of the newly insured.

New enrollees are much sicker—More Diabetes, heart disease, HIV and Hepatitis C

Over the last three years, it has become apparent that new enrollees in the exchanges tend to have more medical problems. Many have gone without treatment for a long time prior to acquiring insurance. These patients often have very advanced disease (along with multiple disease related complications) and by the time they gain access to care and most require expensive, intensive treatments. Newer drugs for diseases such as hepatitis C are priced exorbitantly and costs for a 12-week course of therapy can reach $80 thousand dollars or more. Obesity and obesity related illnesses are epidemic in the US today. Obesity places patients at risk for diabetes, heart disease and other potentially debilitating and costly chronic diseases—accounting for 150 billion dollars of healthcare expenditures in the US annually. Until we focus on preventative efforts and individual accountability these costs will continue to rise.

What is to be done to save healthcare in the US?

We must revamp the system. This job will require Congressional action and actual bipartisan cooperation and support. Moreover, both the legislative and executive branches of government will have to come together and actually compromise in order to stop the implosion of the best healthcare system in the world. While providing expanded access to healthcare for all Americans is an important goal, we must develop a system that rewards good health choices and focuses more on disease prevention. We cannot expect, nor rely on, young healthy Americans to completely fund healthcare those who do not even attempt to modify risk and engage in their own healthcare.   We must set up a system of individual accountability where premiums are tiered based on health choices—lower premiums for those who DO NOT smoke, those who exercise and those who avoid other high risk behaviors for example. At best, healthcare in the US is headed for disaster. Unless we can address the rising costs, diminishing choice and pending physician shortages we will soon become a single-payer system—just ask the Canadians how well that has worked out north of the border….

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Making Progress in Social Media and Medicine: Engagement at ACC

This week at the American College of Cardiology meetings I was amazed by the uptick in Social media engagement. While 75% of all fortune 500 companies are represented and active on twitter, doctors have been quite slow to enter into the social media space. Many of us have who have pioneered social media in medicine have often felt like Dr. Sisyphus as we push the “Social Boulder” up the hill in order to show our colleagues the value of digital engagement. However, it appears that finally the tide is turning…..

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From the very outset of the meeting the hashtag #ACC16 began trending. Just in time for the annual sessions, the American College of Cardiology recently created and published a Cardiology Hastag Ontology reference guide in order to bring together the broad topics within cardiovascular disease so that common subjects of discussion can be easily identified, searched and catalogued.

Analytics from #ACC16 demonstrated that by meetings’ end, there were nearly 3600 individual tweets, 35 million individual impressions with roughly 1500 members participating via social media platforms such as twitter. During the meeting, there was an average of 155 tweets per hour and many participants “live tweeted” during important presentations such as the late breaking clinical trials sessions on each day. Leadership in digital engagement was spread among individual attendees, twitter feeds from the college itself as well as feeds from institutions such as the Mayo and Cleveland Clinics. Interestingly, the “Top 10 Influencers” by impressions were not the same as the Top 10 by tweets—suggesting that WHAT you say may be more influential that HOW MUCH you say in the digital space.

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Screenshot via Symplur at #ACC16

Furthering the importance of social media and mobile health in medicine at ACC, a novel study evaluating the use of digital tools for engaging patients on outcomes was presented at the meeting as well. Researchers from Mayo clinic investigated whether or not patients undergoing cardiac rehabilitation would benefit from using specially designed health tools on their smartphones. In the study, 80 patients were randomized to a group having access to a smartphone mobile health tool with cardiac rehabilitation versus rehabilitation alone. Primary endpoint was total weight loss in the 12-week time period. The mobile tool group lost four times as much weight compared with those undergoing 12 weeks of cardiac rehabilitation alone. This randomized controlled trial is the first in the U.S. to look at how adding the use of mobile and wireless devices concurrently with cardiac rehab might improve health outcomes—and clearly demonstrates the power of patient engagement via digital platforms.

Once again, social media sessions were included as part of the Annual Scientific Meetings academic programming. I was honored to chair and participate in the session alongside many distinguished colleagues. The session was well attended and each talk was delivered in a TED talk style format—emphasizing audience engagement, interaction and story-telling. Slides contained images rather than charts and each speaker shared real world experiences and examples of social media and digital successes. Topics included the use of social media for connectivity, engagement and innovation.   The expanding use of mobile tools for the advancement of clinical trials was explored as well as issues surrounding direct patient engagement.

It is clear that the American College of Cardiology has embraced the digital space. As cardiologists we are innovators and social media and digital engagement should be no exception. The future of social media in medicine is limitless—it is my hope that in 2017, we add to the numbers of active healthcare providers on social media.   Ultimately, engagement can only help the people that we are pledged to serve—our patients. Through embracing our digital future in medicine, we can improve outcomes, improve disease awareness and access to care and provide new tools for disease management. Lets all be part of the leading edge of the bell curve—As Rogers shows us in Diffusion of Innovations, we must be the early adopters…not the laggards, in order to maximize success.

 

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Rogers, EM Diffusion of Innovations, 2003